Supporting Mental Health Initiatives in the Ithaca Community

Ryan Lombardi

In a scathing critique of student mental health at Ivy League schools, a new report gives Cornell University a grade of D- for its mental health leave of absence policy. No Ivy scored higher than a D, and Yale and Dartmouth were assigned F grades.

“The leave of absence policies do not reflect institutional commitment to supporting students with mental health disabilities,” the report said. “When it comes to inclusion of students with mental health disabilities, the Ivy League schools do not provide the leadership that the landscape of higher education desperately needs…The findings demonstrate that the Ivy League schools, the most elite institutions in our nation, are failing to lead the sector of higher education in supporting students with mental health disabilities.”

While generally critical of how universities are meeting student mental health challenges, the report focuses on the aspect of leave of absence policies. Noting that a health leave is a potentially useful mechanism enabling a student to focus on well being and recovery, “schools may also use the leave of absence as a tool for discrimination, pushing students out of school who are entitled by law to receive accommodations and supports which would enable them to stay.”

The report claims that college campuses are facing a unique crisis, arguing that the prevalence rates of mental illness among college students are far larger than prevalence rates for age-matched non-college individuals.

The Ruderman report says:

“Meanwhile, college resources provide woefully inadequate support to students. … The scope of the problem, combined with the lack of resources available to address the problem, is exerting a horrible toll. Suicide is among the most tragic consequences of untreated mental illness and it is the second leading cause of death of college students…”

“Clearly, colleges need to invest in increasing the availability of mental health professionals on campus. One clinician for every one thousand students is not enough, and this ratio represents the availability of clinicians on the campuses with the most resources.”

The report speculates that college administrators are wary of bad press coverage about campus suicides, and that their fear of a lawsuit if a student takes their own life motivates them to remove students from campus.

In the study, Ruderman cited “problematic” issues in seven of 15 categories related to Cornell’s leave of absence policy. It said there was “room for improvement” in two other issues, and that the university followed “best practice” in six others.

Here are the 15 categories and Cornell’s scores in them:

PUTTING A STUDENT ON LEAVE

1. Does the involuntary leave policy include “threat to self” language (with the premise that the inclusion of this language is facially discriminatory)?

The policy states, “…whether the student’s behavior is disruptive of the university’s learning environment and whether the behavior poses a direct threat to the safety of others…”

Grade: Best Practice

2. Do leave policies specify that the student is entitled to reasonable accommodations which would enable them to stay at school?

The policy states, “Consideration will also be given to accommodations that may reasonably be provided that will mitigate the need for the involuntary leave.” There is no mention of individualized assessment.

Grade: Ambiguous / Room for improvement

3. Do leave policies include language against generalization, fear, or stereotype?

There is no language against generalization, fear, or stereotype.

Grade: Problematic

4. Is there language about community disruption?

The policy states, “When there is an actual or the threat of a community disruption, Cornell University may place a student on an involuntary leave of absence.”

Grade: Problematic

5. Does the policy empower students to work with mental health professionals of their choice?

The student must get approval to take a leave and return from leave from Cornell Health (it can’t be an outside treatment provider). Also, a Cornell Health clinician or counselor will provide “…specific treatment recommendations as part of the HLOA agreement. Compliance with the treatment expectations is a primary factor in approving a student’s return to Cornell.”

Grade: Problematic

6. Can the student initiate the process at any time?

There are no health leaves of absence after the last day of classes.

Grade: Problematic

7. Are policies and procedures transparent?

All decisions regarding return from an HLOA are made by an interdisciplinary committee of Cornell Health clinicians. Student requests to return are denied only when the committee is unanimous in its opinion that a return is not advisable at this time. The return process checklist also provides transparency. Also, the involuntary leave policy states that involuntary leaves are imposed only “in extraordinary circumstances.”

Grade: Best practice

THE LEAVE ITSELF

8. Is there a minimum length of time for the leave?

The policy states, “The duration of the leave is to be determined by the vice president for student and campus life based on the facts and circumstances leading up to the imposition of the involuntary leave…For health leave, amount of time will depend on the circumstances.” The mental health provider report requests information, including “Once achieved, has the substantial reduction [in behaviors such as suicidal behaviors, self injury, food purging] been maintained stably for 3 consecutive months?” This may suggest that three months is the minimum duration.

Grade: Ambiguous / Room for improvement

9. Does the school specify a maximum duration or maximum number of leaves?

There is no language about maximum number or duration.

Grade: Best Practice

10. Does the policy identify a liaison or contact person at the school?

The policy does not identify a liaison or a contact person.

Grade: Problematic

11. Are students on leave prohibited from visiting campus?

The policy states, “The student may visit campus only as authorized in writing by the vice president for student and campus life.” The policy states, “Where appropriate, impose a persona non grata order on a student who has been placed on involuntary leave.”

Grade: Problematic

12. Are there work or school requirements?

The policy states, “It is expected that the student uses the time away from the University for treatment and recovery.” The policy states, “Until the student complies with the pre-requisites to enrollment mandated by the vice president for student and campus life. An individualized assessment will be made for the student to determine if the pre-requisites have been satisfied.”

Grade: Best practice

RETURNING FROM LEAVE

13. What is the deadline to apply for return?

The student must notify Cornell Health in writing of their wish to return by June 1 for a Fall return and November 1 for a Spring return. Submit documentation by July 1 for fall semester return, by December 1 for spring semester return. The score is based on the documentation deadlines.

Grade: Best Practice

14. Does the policy mention confidentiality, and facilitate confidentiality by specifying that medical records should be submitted to health services, not school administration?

Voluntary leave policy states – “December 22, 2017: Added note at end of procedures indicating that requests for health-care related leaves should be referred to Cornell Health to initiate the HLOA [Health Leave of Absence] process, and that academic units should not request health information or medical records directly from a student.” There is no explicit mention of confidentiality.

Grade: Ambiguous / Room for improvement

15. Does the policy facilitate student participation in university housing?

The policy does not mention housing.

Grade: Problematic

The rating system allotted a score of 1 if problematic, 2 if there was room for improvement, and 3 for best practice.

In 2017, The Sophie Fund, an Ithaca nonprofit organization advocating for youth mental heath, released a proposal aimed at supporting students taking leaves of absence for mental health reasons from Cornell University, Ithaca College, and Tompkins Cortland Community College.

The proposal calls for an Ithaca community-based program featuring a “leave of absence coach,” a community outreach worker providing practical guidance and moral support for students in transition. It also proposes a website hosting useful information about college leave policies, strategies for fruitful time off from school, local housing options, and employment opportunities. To date, no tangible progress has been made in funding or implementing the proposal.

“Leaves of absence entail an often unexpected, abrupt, and painful loss of a structured environment that includes a support network of friends, professors, university staff, roommates and other fellow students, campus organizations, cultural and athletic facilities, and school medical providers,” the proposal says. “Testimonies from students on mental health leaves of absence relate how it can be a confidence-crushing experience that induces shame and guilt.”

In April 2017 and again in August 2018, The Sophie Fund’s founders, Scott MacLeod and Susan Hack, called on Cornell University President Martha E. Pollack to launch an independent external-led review of student mental health. They said the review should include “Cornell’s policies, programs, and practices for students taking HLOA for mental health reasons.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

The student-run Cornell Mental Health Task Force has issued a set of recommendations for immediate steps to improve the campus climate and services for mental health, and called on the university administration to ensure that an upcoming comprehensive review of student mental health is “independent, thorough, and transparent,” and involves “full student participation.”

Statue of Ezra Cornell in the Arts Quad

The recommendations addressed to the Cornell administration proposed three immediate initiatives to be carried out in two phases, covering improvements in student mental health services, mental health education and collaboration within the Cornell community, and academic policies and practices that impact student mental health.

The task force also called for the creation of “an official Standing Committee on Mental Health,” comprised of task force members and other students, “tasked with overseeing ongoing implementation of best practices for student mental health, reviews, and serving as a liaison between students and their needs and the administration.”

The task force, co-chaired by Matthew Jirsa ’19 and Joanna Hua ’20 and consisting of more than 20 students, issued the recommendations earlier this week after a six-month study and following an October 19 public forum where draft recommendations were presented and discussed.

Specific recommendations of the task force included:

Hiring more psychological counselors to accommodate rising numbers of students seeking services; reducing wait times for counseling appointments; requiring counselors to undergo diversity training; improving access to off-campus psychological services; requiring mandatory suicide prevention training for Resident Advisors; requiring mandatory mental health training and an accountability system for faculty; introducing a standardized grading system to reduce academic stress; creating a student mental health advocate; providing support to students at every stage of the process for taking a leave of absence for mental health reasons.

In its letter, the task force said it sought to collaborate with the administration “to mutually work towards profound change, with the ultimate end of making Cornell a standout institution where mental health is holistically and completely championed, academically, clinically, and culturally.”

The task force applauded recent announcements by President Martha E. Pollack and Vice President Ryan Lombardi that the administration intends to launch a “comprehensive” review of student mental health. The task force added: “We call on the administration to ensure that this review is independent, thorough, and transparent, includes full student participation, and strives to become a ‘gold standard’ for addressing mental health on the college level to which other universities can look for guidance.”

The task force commended many aspects of Cornell’s current mental health efforts, noting the hiring of additional Counseling and Psychological Services (CAPS) counselors, the recent formation of a broad-based campus Coalition on Mental Health, and ongoing support for peer-to-peer programs aimed at reducing stress. “These measures are a fantastic start, but with high wait times [for CAPS appointments] and recent incidents of suicide attempts, we are far from where we need to be,” the task force said.

The task force said that Cornell’s “Ivy-League culture of hyper-competition and ‘stress Olympics’ is centered in the middle of a rural health system—a situation that creates a high demand for mental health services despite rural issues of lower mental health professional supply.” It cited Cornell Pulse data indicating that four of 10 undergraduates surveyed were “unable to function academically for at least a week in the past year due to depression, stress, or anxiety” and that 12 percent of surveyed Cornell students had seriously considered suicide within the past year.

—Develop a system of intaking students that is more efficient, shortening wait times and improving access while also ensuring quality of care.

—Pledge to hire new counselors in the event that the number of students seeking CAPS services continues to rise in the coming semesters/years.

—Seek input from the student body concerning whether or not the current counselors are diverse and adequately understand a broad range of mental health concerns.

—Require all counselors to obtain a baseline of diversity training in order to accommodate for the diversity and intersectionality of mental health concerns.

—Share estimated wait times for appointments with counselors on the Cornell Health website for transparency.

—Create a mechanism for anonymous referrals of persons in distress to mental health resources before extreme actions such as calling the police.

—Establish a clear and straightforward method for switching counselors within Cornell Health if requested.

—Create of a page on the Cornell Health website that addresses considerations that are made when matching patients with counselors, clearly outlines the process for switching to a new counselor, and lists resources for students who are unhappy with their care (i.e. patient advocates).

—Allow students to state their counselor preferences (demographic, personality type, etc.) during the 15-minute phone screening and accommodate their requests.

—Create an anonymous outlet for students to voice complaints about their counselor to be utilized in counselor training.

—Enable students to change counselors by speaking with a receptionist or patient advocate, or by sending an email to their counselor.

—Create an Off-Campus Therapy Referral Network to sustain relationships with therapists in the Ithaca community.

—Provide an easily accessible list of off-campus therapists accepting Cornell students and accepting the Student Health Plan including those willing to offer prorated/discounted prices.